Fetal Endoscopic Tracheal Occlusion (FETO) for Left and Right Congenital Diaphragmatic Hernia in Canada

To describe perinatal and short-term pediatric outcomes and procedural safety of fetal endoscopic tracheal occlusion (FETO) in a Canadian national referral centre.

Retrospective study including all consecutive FETO cases at the Ontario Fetal Centre between 2010 and 2024. Maternal and fetal baseline characteristics, technical aspects and short-term outcomes until 6 months are described.

FETO was successfully performed in 47/48 (98%) cases at an average gestational age (GA) of 28.5 (24-31.6) weeks including 22 (47%) moderate LCDH (M-LCDH), 12 (25%) severe LCDH (S-LCDH) and 13 (28%) right CDH (RCDH). There were no major complications. Balloon removals were emergent in 23/46 (50%) and challenging in 14/46 (30%) of cases. Preterm premature rupture of membranes (< 37 weeks) occurred in 70% (33/47) with average GA at birth of 35.9 weeks (29.0-40.4 weeks). Survival to discharge was 54% (25/46), specifically 64% (14/22), 33% (4/12), and 58% (7/12) among M-LCDH, S-LCDH and RCDH, respectively. Patch repair was performed in 28/30 (93%). Supplemental oxygen and tube feeding were required in 32% (8/25) and 68% (15/22) of survivors at discharge, respectively.

In this North American series, FETO outcomes were similar to those observed in international trials, confirming its effectiveness. Studies are ongoing to evaluate long-term outcomes.